EMERGENCY CONTACTS (NEXT AFTER PARENTS) AUTHORISED TO COLLECT CHILD

Could you supply us with the following information of names and telephone numbers of three people who are authorized to pick up your child? Also to be used as an emergency contact only when you are not available.

Contact 1

Surname(*)

Please let us know your name.

Christian Names(*)

Address

Please let us know your message.

Home Phone(*)

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Mobile

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Work Phone

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Relation to Child

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Contact 2

Surname(*)

Please let us know your name.

Christian Names(*)

Address

Please let us know your message.

Home Phone(*)

Invalid Input

Mobile

Invalid Input

Work Phone

Invalid Input

Relation to Child

Invalid Input

Contact 3

Surname(*)

Please let us know your name.

Christian Names(*)

Address

Please let us know your message.

Home Phone(*)

Invalid Input

Mobile

Invalid Input

Work Phone

Invalid Input

Relation to Child

Invalid Input

Permission

I give the management/staff of Walkley Heights Child Care Centre the authority:

To complete observations for use within the centre or where staff are studying, however, if questioning or testing of the child is undertaken my permission will be sought beforehand.

YesNoInvalid Input

For my child to take part in supervised short walking excursions within the local area as part of the centres program.

YesNoInvalid Input

To use the name and/or photo of my child for the centre displays and/or promotional use, including media and website.

YesNoInvalid Input

To apply foreign substances eg. Sunscreen, nappy change lotion, nappy powder or any other substance required onto my child’s skin as the need arises. (Donation of $2.00 for sunscreen is required from time to time or you can provide your own)

YesNoInvalid Input

To be checked for Head lice where necessary

YesNoInvalid Input

To administer Panadol (Paracetamol)

YesNoInvalid Input

To be involved in water play based experiences

YesNoInvalid Input

To have basic first aid applied if necessary eg bandaids

YesNoInvalid Input

I give Permission for the staff of Walkley Heights Child Care Centre to administer Panadol (Paracetamol) to my child should they have a fever and all other methods used to lower the temperature have failed, ie Tepid sponging, removal of excess clothing, increased intake of fluids.

I understand that an effort will be made to notify me (or another nominated responsible adult) at the time Panadol (Paracetamol) needs to be administered, and that I (or another nominated responsible adult) may be required to collect my child immediately. If contact is unable to be made, then, in the interests of the health and comfort of my child, the Panadol (Paracetamol) will be administered.

I agree

YesInvalid Input

Medical Emergency

In case of accident or emergency, every effort will be made to contact the parents immediately.

I

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(Parent/Guardian) authorize the staff of Walkley Heights Child Care Centre, in the event that my child requires urgent Medical attention, to obtain medical assistance which they deem necessary and agree to pay any medical and transport costs incurred.

I agree to indemnify Walkley Heights Child Care Centre, and its staff, against any liability relating to or incidental to Walkley Heights Child Care Centre custody and care of my child, except where such liability is directly caused by any willful act or omission of Walkley Heights Child Care Centre or its servants or agents.

I agree

YesInvalid Input

Fee Agreement

It is the responsibility of parent/guardians to ensure that the enrolment form is completed in full, and returned to the centre prior to commencement of care. This form provides the centre’s link to you as parents/guardians in case of an emergency.

I undertake to pay the fees weekly in advance.

I understand that the fees must be paid regardless of attendance, eg Sickness, Public Holidays, or Annual Leave and I understand there will be no swapping of day or “making up” of days not attended.

Fees for holidays must be paid in advance prior to your child commencing such leave.

If my fees are in arrears for more than two weeks and no arrangements have been made with the Centre, my child’s place will be withdrawn. Should I fail to pay my fees and my place is withdrawn or when I leave the Centre I will be liable for all additional costs incurred by the centre in collecting the outstanding fees.

Full fees are payable until my Child Care Benefit Confirmation is received by the centre.

Notice: When my child is leaving Walkley Heights Child Care Centre or reducing the number of days of attendance, I must give two weeks written notice or pay appropriate fees in lieu of such notice.

I agree

YesInvalid Input

Other Comments

Our staff take this opportunity in welcoming you and your family to our centre, and trust that your association with us is a happy one.